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Perspectives on Endodontic
Therapy and Instrumentation
A Peer-Reviewed Publication
Written by John C. Comisi, DDS, MAGD

Abstract Learning Objectives: Author Profiles

Endodontic treatment has as its overall goal the long-term
retention and restoration of the endodontically treated tooth,
including an absence of periapical infection. For this to be
achieved, a number of steps and a careful technique are
required during instrumentation and irrigation for cleansing
and shaping of the canals, and during root canal obturation.
Over time, root canal instrumentation options increased to
include NiTi reamers and files, Gates Glidden drills, and other
designs for manual and rotary use. Instrumentation options
and techniques for obturation also increased to include
traditional lateral and vertical cold condensation techniques,
as well as techniques utilizing carriers of different designs
and new materials. Regardless of which combination
of instrumentation and techniques is used, successful
endodontic therapy relies on a number of sequential steps
that must be thoroughly carried out.
The overall goal of this course is to provide the reader with
an overview of root canal instrumentation and obturation
techniques.
On completion of this course, the reader will be able to do the
following:
1. List and describe the overall goal and objectives of
endodontic treatment.
2. Define and describe endodontic instrumentation options.
3. Discuss the requirements for a root canal irrigant.
4. List and describe currently available root canal obturation
techniques.
John C. Comisi, DDS, MAGD
Dr. Comisi has been in private practice in Ithaca, NY since
1983. He is a graduate of Northwestern University Dental
School and received his Bachelor of Science in Biology
at Fordham University. He is a member of the American
Dental Association and its tripartite organizations, the
Academy of General Dentistry, the American Equilibration
Society, the International and American Association
of Dental Research, a Research Associate at New York
University Dental School. Dr. Comisi is a Master of the
Academy of General Dentistry, and holds Fellowships in
the Academy of Dentistry International, the American
College of Dentistry, the Pierre Fauchard Academy and the
International College of Dentistry.
Author Disclosure
The author(s) of this course has/have no commercial ties
with the sponsors or the providers of the unrestricted
educational grant for this course.

Publication date: Sept. 2011 Go Green, Go Online to take your course

Expiration date: Aug. 2014 PennWell designates this activity for 2 Continuing Educational Credits This course has been made possible through an unrestricted educational grant.

Supplement to PennWell Publications
This course was written for dentists, dental hygienists and assistants, from novice to skilled.
Educational Methods: This course is a self-instructional journal and web activity.
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Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay
the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.
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to result in the participant being an expert in the field related to the course topic. It is a combination of many
educational courses and clinical experience that allows the participant to develop skills and expertise.
Registration: The cost of this CE course is $49.00 for 2 CE credits.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a
full refund by contacting PennWell in writing.
Educational Objectives
The overall objective of this course is to provide the reader
with an overview of root canal instrumentation and obtu-
ration techniques.
On completion of this course, the reader will be able to do
the following:
1. List and describe the overall goal and objectives of
endodontic treatment.
2. Define and describe endodontic instrumentation
options.
3. Discuss the requirements for a root canal irrigant.
4. List and describe currently available root canal obtura-
tion techniques.
Abstract
Endodontic treatment has as its overall goal the long-term
retention and restoration of the endodontically treated
tooth, including an absence of periapical infection. For
this to be achieved, a number of steps and a careful tech-
nique are required during instrumentation and irrigation
for cleansing and shaping of the canals, and during root
canal obturation.
Over time, root canal instrumentation options developed
to include NiTi reamers and files, Gates Glidden drills, and
other designs for manual and rotary use. Instrumentation
options and techniques for obturation also increased to
include traditional lateral and vertical cold condensation
techniques, as well as techniques utilizing carriers and new
materials. Regardless of which combination of instrumenta-
tion and techniques is used, successful endodontic therapy
relies on a number of sequential steps that must be thor-
oughly carried out.
Introduction
The landscape of the science of endodontics has evolved
over the last few decades, and continues to do so. Initially,
the science of endodontics was not fully understood, and
incomplete or partial pulpotomies were considered the
standard of care. As the science and evidence for end-
odontics developed, it was understood that, in cases of
irreversible pulpitis, pulpectomy was required to success-
fully treat these teeth. Endodontic treatment can involve
nonsurgical or/and surgical treatment. For the purposes
of this article, we will focus on nonsurgical treatment. As
endodontic techniques developed, success rates increased.
Current and recent treatment modalities have resulted in
success rates of up to 98% where no apical periodontitis
was present at the time of treatment; this, together with
the ability to thoroughly prepare and fill the root canal
system, is a primary factor in the success or failure of pulp-
ectomies.1,2 Other factors include the type of restoration
placed following endodontic treatment, with higher tooth
retention and success rates generally found in crowned
teeth compared to uncrowned teeth.3,4
2 www.ineedce.com
The ability to thoroughly prepare and fill
the root canal system is a primary factor
in the success or failure of pulpectomies.
The overall goal is the long-term retention and restora-
tion of the tooth with complete healing of the periapical
tissues. The objectives are to completely remove all ne-
crotic and/or vital pulpal tissue and debris from the canal
system, eliminate microbes, and cleanse and shape the
canal system. After this, the root canal system is obturated
to create a hermetic seal in all 3 dimensions of the root canal
system—apically and coronally, and laterally for accessory
canals. If any of the steps involved are inadequate, the end-
odontic outcome is compromised. Problems can include
the continued presence or recurrence of periapical infec-
tion and a lack of healing;5 perforation of the root during
inappropriate instrumentation and over-instrumentation;
lack of a coronal seal; coronal fracture; and subsequent root
fracture, which may be associated with over-instrumen-
tation during endodontic treatment or post preparation,
resulting in thin dentinal walls of the roots that are then
predisposed to fracture.6,7,8 Success in achieving the objec-
tives of endodontic therapy is dependent on the use of a
thorough, step-by-step technique utilizing suitable instru-
mentation, irrigation, and obturation materials.
Success in achieving the objectives of endodontic
therapy is dependent on the use of a thorough,
step-by-step technique.
Endodontic Instrumentation
To begin nonsurgical endodontic treatment, one accesses
the pulp chamber and root canals coronally using straight-
line access. Endodontic instruments have been developed
to include manual, mechanical, and ultrasonic instruments.
Endodontic files and reamers of various types can be used
to cleanse and shape the canals, with intermittent irriga-
tion providing for disinfection and the removal of debris.
Clinical proficiency is required to achieve these goals. Care
must be taken during treatment to prevent blockage of the
canal system, the creation of ledges or “pseudo” canals,
and of course, perforation of the canal. Should any of these
problems occur, they could ultimately lead to failure of the
endodontically treated tooth.9 (Table 1)
To additionally complicate treatment, obstructions
of the upper chamber of the root canal system can result
from the presence of calcified structures and stones that
can occur naturally as a physiological response to various
challenges experienced by the tooth.10 Caries advancement,
“conservative” dental treatment, aging of the tooth, oc-
clusal forces, and parafunctional habits can all lead to this
calcification process. Calcifications, as well as anastomoses
or isthmuses, and accessory canals, can make it difficult Figure 2. Hedstrom files
to thoroughly instrument, cleanse, and shape the canals.
(Figure 1) Such problems of accessibility can result in the
persistence of microbes and residual infection, the inability
of irrigants to reach the area, and difficulties in sampling to
determine whether a microbial load is still present.11

Table 1. Potential complications during and following treatment

Continued presence of infection
Canal blockage
Overinstrumentation
Root canal perforation
Figure 3. Sharp-tipped Gates-Glidden drills
Creation of ledges and pseudo canals
Lack of coronal seal
Recurring infection
Coronal fracture

In order to navigate through calcified structures, the

clinician will first attempt to negotiate the canal system
with very sharp pointed-tip files, typically No. 8 or No.
10 files. It has been suggested12 that these files should
be precurved to increase the tactile sensitivity of the op-
erator and should be used with minimal apically directed
pressure during attempts to slip and slide between these
“stones” and gain access to the original path of the canal.
Once this is done, the debris can be removed with a back-
ward carving motion and larger instrumentation (such as
files and reamers of various designs including Hedstrom
files with backward-facing cutting edges for rapid canal
enlargement) can be introduced to continue the cleansing
and shaping of the canal system. Once this is done, the
debris can be removed with a back-ward carving motion
and larger instrumentation can be introduced to continue
the cleansing and shaping of the canal system. (Figure 2)
Sharp-tipped Gates-Glidden drills have also been used to
remove calcified tooth structure and gain access. (Figure 3)
The process can be very time consuming and needs to be
carried out with care and patience. For the removal of the
pulp and pulpal remnants, barbed broaches are often used.
Figure 1. Calcifications
During the ’60s, ’70s, and ’80s, hand instrumentation and
a “watch winding” technique became a standard, whereby
reamers were used, intermittently followed by files and irrig-
ants. This “watch winding” technique involved rotating the
files 20 to 30 degrees, sequentially and repeatedly, in clockwise
and counterclockwise directions using only light apical pres-
sure and allowing the files to advance. Each file size was used for
no more than 10 seconds and the next file was then used. Many
different concepts and systems have been developed over the
years to make the procedure easier and more predictable for
the clinician, and instrumentation of the canal systems has also
undergone multiple changes. Curvatures of the canal systems,
which are inevitably present in many cases, created havoc with
many treatment techniques rendered over the years. (Figure 4)
Precurving of stainless steel files was found to be a necessary
technique addition as the science of endodontics evolved.13
Figure 4. Curvature of canals

Image courtesy of Dr. Manish Garala

www.ineedce.com 3
 The introduction of Ni-Ti hand files eliminated the
need for precurving, since these files have the ability to
navigate the canal system and aid in the cleansing and
shaping of curved canals. However, metal fatigue was and
is seen when Ni-Ti files are used or if any attempt to pre-
curve these instruments is made, thus leading to the pos-
sibility of separation of the file within the canal, creating
additional treatment complications.14,15 The development
of rotary Ni-Ti instruments is often considered one of the
most important advances in endodontic treatment. This
has led to the creation of numerous rotary instrumentation
systems that have certainly helped enhance the care ren-
dered for our patients and have decreased the time needed
to treat endodontic cases. With rotary Ni-Ti files we have
improved the overall efficiency of endodontic treatment.16
Ni-Ti rotary systems have been developed for both the
“step down” and the “step back” techniques. (Figure 5) To
overcome rotary NiTi drawbacks, several alternatives were
developed.
The “step back” or serial technique uses fine instruments
starting at the apex and working up the canal with progres-
sively larger instruments,17 is used with hand instruments,
and was designed to help reduce instrument transportation
or “zipping” in the apical third of the canal system. “Zip-
ping” damage destroys the apical constriction, transports
the narrowest widths of the canal, and prevents proper
cleansing and filling of the apical region of the canal system.
The “step down” or “crown down” technique18 requires
starting with larger instruments at the orifice of the canal
and gradually moving toward the apex with smaller and
smaller instruments. There have also been modifications
and blendings of both techniques in attempts to simplify the
procedures. An apex locator is helpful and can be attached
to rotary Ni-Ti reamers while instrumentation of the canals
is carried out.
Figure 5. The “step down” or “crown down” technique
Source: Charles J. Goodis, DDS, Mandibular Molar Endodontic Treatment: Maximizing Efficient
and Safe Endodontic Therapy
4 www.ineedce.com
Each instrumentation system uses a set sequence of Ni-
Ti rotary files requiring a number of steps and instruments.
Along with the improvements in speed and efficiency,
variations in the shapes created by these instruments at the
apex occur, and there is the potential for canal transporta-
tion and excessive dentin removal. One of these involved
the use of instruments with variable tapers along the flutes
to achieve better access, efficiency, and safety. Additional
goals of this system were to avoid overpreparation of the
coronal portion of the canal and to be able to shape the
majority of canals with a minimum number of rotary files
(typically up to 4). Ground as well as twisted Ni-Ti files are
now available. Recent studies suggest that engine-driven
instruments, which are usually used with a crown-down
technique, are more effective than hand instruments and
result in fewer instrument fractures.19
Table 2. Instrumentation methods
Hand instruments: files, reamers, broaches, and Hedstrom files
Engine-driven instruments with and without a reciprocating
handpiece
Gates Glidden drills
Peezo reamers
Sonic and ultrasonic instrumentation
Another advancement has been an instrumentation
system that combines the use of stainless steel-relieved
reamers along with a Peezo-like instrument and Ni-Ti
reamers. These reamers consist of a series of noncircular,
noninterrupted flat-sided reamers that are designed to
reduce endodontic stress and instrument separation.20
(Table 2) The relieved areas are claimed to result in
less engagement and catching on the dentinal walls of
the root canals (Figure 6), thus bringing less risk of file
separation, while the vertical blades and flat sides are
designed to increase debris removal during instrumenta-
tion and the cutting tip allows the reamer to pierce the
tooth tissue without creating resistance. While similar to
stainless steel or Ni-Ti files and reamers in that they have
the typical “handle” on each instrument, these instru-
ments have one side that is flat with 16 flutes, as opposed
to standard files, which are rounded and have 24 flutes.
These reamers are used with a reciprocating handpiece to
shape and prepare the root canal system. As with all ro-
tary endodontic instruments, the hand motion is up and
down in a piston-like fashion, although with less force,
and the handpiece reciprocation rotates the reamers in a
30-degree clockwise/counterclockwise motion. As with
several other systems, if desired, the reamers can first be
used for hand instrumentation using the watch-winding
technique.
Figure 6. Visible aspect of flat-sided reamer
Irrespective of the system used, the canals are flared
after attainment of working length. In the case of a curved
canal, care must be taken to ensure that flaring does not
result in acentric shaping of the canal or, in extreme cases,
perforation of the canal or reduction of dentin thickness
adjacent to furcations, as this could result in subsequent
perforation of the tooth. (Figure 7)
Recent studies suggest that engine-driven instruments,
which are usually used with a crown-down technique,
are more effective than hand instruments and
result in fewer instrument fractures.
Figure 7. Flaring a curved canal
Irrigation
Proper irrigation of the root canals during shaping and
cleansing is essential to remove debris and microbes as well
as the smear layer present on the dentinal walls. The irrig-
ant should have broad antimicrobial properties and have the
ability to safely and effectively disinfect the canals, dissolve
organic tissue (necrotic and pulpal) and inorganic tissue,
and remove debris. Available root canal irrigants include
sodium hypochlorite, hydrogen peroxide, chlorhexidine
gluconate, ethylenediaminetetraacetic acid (EDTA), and
alcohol. However, Enterococcus faecalis and Actinomyces
israelii—which are both implicated in endodontic infections
as well as in endodontic failure—penetrate deep into the
dentinal tubules, making their removal through mechanical
www.ineedce.com 5
instrumentation impossible and making irrigant selection
and use critical.21,22 The ability of the irrigant to remove
the smear layer (alone or in combination with another irrig-
ant), dissolve organic and inorganic materials, and remove
debris, as well as its biocompatibility, must be considered.
Regarding the calcifications referred to earlier in this article,
in addition to root canal instrumentation to remove these,
EDTA is helpful.23,24 Further, the irrigation technique must
include intermittent irrigant use between instrumentation
steps and must prevent extrusion of the irrigant through the
apex or lateral canals and not let it reach the intra-oral envi-
ronment (the latter accomplished by use of a rubber dam).
The full length of the canal walls must be reached.
The ability of an irrigant to remove the smear
layer, dissolve organic and inorganic
materials, and remove debris, as well as its
biocompatibility, must be considered.
Root Canal Fillers and Canal Obturation
Filling materials such as silver points were used for a period
of time, until it was discovered that the excessive use of this
material could lead to argyria, a condition caused by the
improper exposure to chemical forms of the element silver,
which in the most extreme of situations can turn the skin
blue or bluish-gray in color. The use of such materials in
combination with sealers also resulted in root canal fillings
that were inadequate for obturation and corroded.25 Gutta-
percha, derived from tropical trees in the South Pacific, is
both bioinert and resilient and is combined with zinc oxide,
plasticizers, and radiopacifiers to create gutta-percha points.
Its biocompatibility and malleability have given it an impor-
tant role in endodontics, and it has become the standard ma-
terial used in the obturation of endodontically treated teeth.
This material is available in various taper configurations.
Gutta-percha has been used in a cold lateral condensa-
tion technique and a warm vertical condensation technique.
The lateral condensation technique requires the use of a
“master cone” of gutta-percha, which needs to fit so that it
exhibits a “tug back” within the apical third of the canal.
Once this is achieved, the “master cone” is coated with an
endodontic “sealer” material and placed in the canal, after
which a radiograph must be taken to ensure that the mas-
ter cone is correctly positioned apically. Using endodontic
spreaders, multiple accessory gutta-percha cones are then
laterally condensed around the master cone in order to cre-
ate a deformation in the material against the other cones.
This allows complete filling of the canal system while trying
to create a “cold weld” of the material.
One of the most commonly used sealer materials for
this and many other endodontic obturation procedures
was a derivation of “Grossman’s Sealer.” The “1974”26
derivation consisted of powder containing hydrogenated
resin, zinc oxide, and anhydrous sodium tetraborate, and
a liquid containing eugenol and 4% zinc chloride solution.
Many commercial derivations of this sealer are still avail-
able today. Sealers can be applied to the root canal system
using Lentulo spinners which are first coated with the
sealer and then placed into the canals without engaging the
walls. (Figure 8) The Lentulo spinners are unidirectional,
and should be rotated slowly to gently release the sealer.
Another option is a bidirectional instrument that, as the
name suggests, moves backwards and forwards. (Figure
9) This bi-directional spiral is first coated with the sealer
- typically expoxy resin - and then placed in the canal. The
bi-directional spiral is used with a slow-speed handpiece,
and the handpiece moves in a piston-like fashion in an up-
and-down motion to gently release the sealer into the canal
and coat it laterally away from the apex, thereby helping to
avoid over-fills.
Figure 8. Lentulo spinner
Figure 9. Bi-directional spiral
Schilder et al. developed a warm gutta-percha technique
that incorporated a vertical pressure applied to compensate
for volume changes that occur as cooling takes place27 in the
gutta-percha. This led to the use of the warm vertical con-
densation technique, whereby the master cone is selected
that will tightly fit the canal to within 0.5 mm to 2 mm of
working length. After application of the sealer, the cone is
placed and condensed with a warm plugger once the coronal
portion of the point has first been removed with a warm in-
strument. By repeating the process with small incremental
lengths of gutta-percha points, and each time more coro-
nally, the clinician can fill the length of the root canal with
condensed gutta-percha.
The curvature and the length of the canal must be
considered with respect to the obturation materials and
technique. Condensation forces can be either lateral forces,
which will push the filling material against the walls of the
canal system and into lateral canals, or vertical forces, which
will push the filling materials in an apical direction and can
increase the risk of extrusion of the material. Optimized
6 www.ineedce.com
condensation forces require a delicate balance between the
taper and diameter of the canal, the master cone, and the
pluggers used for condensation. Use of pluggers that have
similar taper and diameter to that of the master cone will
allow pressure to be directly applied to the gutta-percha and
help prevent pressure against the canal wall, which could
result in damage to the root system.
It is important to avoid overfills during
the obturation procedure.
Many variations were developed on the above con-
cepts, including thermo-plasticized gutta-percha filling
techniques. These include the use of a syringe containing
thermo-plasticized gutta-percha that is extruded into the
canal and back-filled, as well as metal and later plastic
carriers coated with thermo-plasticized gutta-percha that
are placed into the canal once the correct size of carrier has
been determined. (Figure 10) The development of plastic-
core carriers has made it easier to remove the excess length
of the gutta-percha carrier coronally through the use of a
heated instrument. Another carrier-based system uses a
plug of gutta-percha at the apical end of the carrier; the
plug is placed in the canal, and the metal portion sectioned
at the length required coronally to enable sealing of the
canal. Other systems utilize gutta-percha that has been
heated using a device that regulates the temperature of the
thermo-plasticized gutta-percha. (Figure 11) One device
consists of a handheld, battery-operated heated plugger,
again regulating the temperature—in this case of the plug-
ger. Another system combines the use of heated gutta-
percha with use of a spreader tip that can be used with or
without vibration during root canal obturation. This par-
ticular device can be used for either traditional obturation
technique. (Table 3)
Figure 10. Carriers for obturation
 Figure 11. Obturation device for thermo-plastic technique Figure 12a. Endodontic therapy

With all thermo-plastic techniques, the flow of gutta- Figure 12b. Completed endodontic therapy
percha in the heated form into the canal depends on the
condensation forces, root canal anatomy (curvature), the
viscosity of the material and the sealer, and the efficiency
and expertise of the clinician. Consideration must also be
given to the contraction of gutta-percha that can occur as
it cools.

Table 3. Root canal obturating materials

Gutta-percha and sealant
Resin-based filler and sealant
Gutta-percha plastic carriers/cores
Resin-based plastic carriers/cores Case images above courtesy of Dr. Manish Garala

Resin-based fillers and sealant are also available for

root canal obturation. Resin-based systems utilize either Case 2.
a methacrylate resin-based sealant with gutta-percha or In this case, the patient presented with a large distal carious
a methacrylate resin-based sealant together with a resin- lesion in tooth #13. Flat-sided reamers were used during
based core. The objective of this is to bond the core and the endodontic therapy, followed by obturation obtained using
sealant to each other and to the tooth (which cannot be done epoxy resin with a bidriectional spiral instrument followed by
with the use of gutta-percha). Epoxy resin-based sealant is a single gutta-percha cone. (Figures 13a-d)
used with a single gutta-percha master cone, with the epoxy
resin sealant taking up the space around the master cone Figure 13a. Initial presentation
and setting to provide a fill with little or no shrinkage of
the sealant.28 Glass ionomer technology has also been used,
involving a coating incorporated onto gutta-percha points
and use of a complementary glass ionomer sealant. As with
the epoxy resin technique described above, a single master
cone is used. The cases below demonstrate the use of 2 dif-
ferent techniques for endodontic therapy.

Case 1.
In this case, the patient complained of pain in tooth #14.
Following examination it was determined that the patient
had irreversible pulpitis, necessitating endodontic therapy.
Treatment involved the use of twisted Ni-Ti files using the
“crown-down” technique. (Figures 12a,b)

www.ineedce.com 7
Figure 13b. Instruments to working length
Figure 13c. Obturated root canal
Figure 13d. Buildup completed
Conclusion
Many instrumentation and obturation techniques are avail-
able for endodontic therapy. Careful technique and selec-
tion of instruments are essential for successful outcomes,
and clinicians should consider the safety of specific types
of instruments and the effectiveness with which the instru-
ments prepare the canals for obturation.
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1957;65:3-11.
24 Zehnder M. Root canal irrigants review. J Endod. 2006;32:389-98.
25 Seltzer S, Green DB, Weiner N, DeRenzis F. A scanning electron
microscope examination of silver cones removed from endodontically
treated teeth. 1972. J Endod. 2004;30(7):463-74.
26 Mendonça SC, de Carvalho Júnior JR, Guerisoli DM, Pécora JD, de
Sousa-Neto MD. In vitro study of the effect of aged eugenol on the flow,
setting time and adhesion of Grossman root canal sealer. Braz Dent J.
2000;11(2):71-8.
27 Langford A, Cunningham PJ. An evaluation of Schilder’s endodontic
technique. Aust Dent J. 1972;17(5):353-4.
28 Hata G, Imura N, Matsuda T, Kato A, Souza Filho FJ, Toda T. Apical
sealing ability of the EZ-fill obturation technique. J Endod. 2002;28(3)
[abstract PR31]:261.
Author Profile
Dr. Comisi has been in private practice in
Ithaca, NY since 1983. He is a graduate of
Northwestern University Dental School and
received his Bachelor of Science in Biology at
Fordham University. He is a member of the
American Dental Association and its tripar-
tite organizations, the Academy of General
Dentistry, the American Equilibration Society,
the International and American Association of
Dental Research, a Research Associate at New
York University Dental School. Dr. Comisi is a Master of the Acad-
emy of General Dentistry, and holds Fellowships in the Academy of
Dentistry International, the American College of Dentistry, the Pierre
Fauchard Academy and the International College of Dentistry.
Disclaimer
The author(s) of this course has/have no commercial ties with the spon-
sors or the providers of the unrestricted educational grant for this course.
Reader Feedback
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Online Completion
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online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your
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Questions
1. Incomplete or partial pulpotomies 11. _________ can make it difficult to 21. A barbed broach can be used to ______.
_________ considered the standard of thoroughly instrument, cleanse, and a. remove pulpal remnants
care. shape the canals. b. irrigate the canal
a. are a. Accessory canals c. enlarge the canal
b. were b. Anastomoses d. all of the above
c. have never been c. Calcifications 22. Proper irrigation of the root canals
d. are sometimes d. all of the above during shaping and cleansing is essential
2. Current and recent endodontic treatment 12. _________ is a potential complication to remove _________.
modalities have resulted in success rates of during and following endodontic treat- a. debris
up to 98% where _________ was present at ment. b. microbes
the time of treatment. a. Intracanal caries c. the smear layer on the dentinal walls
a. apical periodontitis b. Recurring infection d. all of the above
b. lateral periodontitis c. Recurring apicitis 23. ______ is helpful to remove calcifications.
c. genetically-related periodontitis d. all of the above a. Root canal instrumentation
d. none of the above b. Ethanol
13. In order to navigate through calcified
3. _________ is a primary factor in the structures, the clinician will first attempt c. EDTA
success or failure of pulpectomies. to negotiate the canal system with d. a and c
a. The ability to thoroughly prepare the root canal _________. 24. The _________ technique requires the
system a. flexed oval cross-section files
b. the ability to thoroughly fill the root canal system
use of a “master cone” of gutta-percha,
b. curved lentulo spinners which needs to fit such that it exhibits a
c. The absence of apical periodontitis c. very sharp pointed-tip files
d. all of the above “tug back” within the apical third of the
d. all of the above canal.
4. The overall goal of endodontic therapy is 14. The “watch winding” technique involves a. vertical condensation
_________. rotating the files _________ degrees. b. apical condensation
a. long-term retention of the tooth c. lateral condensation
a. 5 to 10
b. long-term restoration of the tooth d. all of the above
b. 10 to 15
c. complete healing of the periapical tissues
c. 20 to 30 25. The _________ must be considered with
d. all of the above
d. 30 to 40 respect to the obturation materials and
5. The root canal system is obturated to
15. The introduction of Ni-Ti hand files technique.
create a hermetic seal _________.
a. apically eliminated the need for _________ of files. a. curvature of the canal
b. coronally a. prestressing b. length of the canal
c. laterally for accessory canals b. precurving c. number of canals
d. all of the above c. separation d. a and b
d. none of the above 26. _________ is an option for obturation of
6. Thin dentinal walls of the roots are
predisposed to _________ . 16. Ni-Ti files _________. root canals.
a. caries a. have the ability to navigate the canal system a. Thermo-plasticized gutta-percha in a syringe
b. sensitivity b. should always be pretreated b. The use of plastic carriers
c. fracture c. aid in the cleansing and shaping of these curved c. The use of a spreader tip with vibration
d. all of the above canals d. all of the above
d. a and c
7. Success in achieving the objectives of 27. The flow of heated gutta-percha into the
endodontic therapy is dependent on the 17. Ni-Ti rotary systems have been canal depends on the condensation forces
use of a thorough, step-by-step technique developed for the ________ and ________ and _________.
utilizing _________. techniques. a. root canal anatomy
a. suitable instrumentation a. “crown down” and “crown back” b. the viscosity of the material and the sealer
b. irrigation b. “step down” and “step back” c. the efficiency and expertise of the clinician
c. obturation materials c. “step down” and “rotate back” d. all of the above
d. all of the above d. all of the above
28. _________ can be used for transporting
8. ___________ can be used to cleanse and 18. The “step back” technique uses sealer into the root canals.
shape the canals. _________. a. Lentulo spinners
a. Endodontic files and reamers a. large instruments starting at the crown b. Hedstrom files
b. Lentulo spinners b. large instruments starting at the apex c. Bi-directional spiral instruments
c. Gates-Glidden drills c. fine instruments starting at the crown d. a and c
d. none of the above d. fine instruments starting at the apex
29. Resin-based systems utilize _________.
9. _________ could ultimately lead to failure 19. Recent studies suggest that engine- a. a methacrylate resin-based sealant
of the endodontically treated tooth. driven instruments are _________ hand b. a methacrylate resin-based sealant together with a
a. Blockage of the canal system instruments. resin-based core
b. The creation of “pseudo” canals a. less effective than c. a methacrylate resin-based sealant together with a
c. Perforation of the canal b. as effective as silver point
d. all of the above c. more effective than d. a or b
d. all of the above 30. _________ is essential for successful
10. Calcified structures can occur naturally
as a _________ response to various chal- 20. The relieved areas on flat-sided reamers endodontic treatment outcomes.
lenges experienced by the tooth. are intended to _________. a. Careful technique
a. chemical a. result in less engagement b. Careful selection of instruments
b. cellular b. result in less catching c. Consideration of the efficacy and safety of instru-
c. physiological c. bring less risk of file separation ments
d. all of the above d. all of the above d. all of the above

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 ANSWER SHEET

Perspectives on Endodontic Therapy and Instrumentation

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Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all
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1. List and describe the overall goal and objectives of endodontic treatment. Academy of Dental Therapeutics and Stomatology,
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2. Define and describe endodontic instrumentation options. P.O. Box 116, Chesterland, OH 44026
3. Discuss the requirements for a root canal irrigant. or fax to: (440) 845-3447
4. List and describe currently available root canal obturation techniques.
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